title: Improving on-time start of day and end of day for a pediatric surgical service.
abstract: OBJECTIVE
  In multicase pediatric ear, nose, and throat operating rooms (ORs), brief delays in early case start times often produce a cascading effect of lengthy delays by the end of the day and can often lead to patient, family, and staff dissatisfaction and increased labor costs due to unplanned overtime. We sought to improve actual end of day relative to scheduled end of day from 40% to 60%.
  
  
  METHODS
  Key drivers of the process included case scheduling, ordering of sedative medications, and nurse availability in the post anesthesia care unit to receive the patient from the anesthesia provider. A multidisciplinary team conducted a series of tests of change addressing the various key drivers. Data were collected by using an independent, impartial data collector as well as being extracted from the hospital information technology system. Data were analyzed by using control charts and statistical process control methods.
  
  
  RESULTS
  The percentage of ORs ending on time increased from 40% to 60%. Appropriate scheduling of complex cases increased from 10% to 87%, and accurate scheduling of case duration improved from 21% to 48%. Timely premedication increased from 55% to 90% and immediate availability of a nurse in the postanesthesia care unit from 68% to.90%.
  
  
  CONCLUSIONS
  By applying quality-improvement methods, significant improvements were made in a multicase pediatric ear, nose, and throat OR. The impact can be significant by reducing wait times for patients, as well as staff overtime for the institution.
authors.affiliation: Departments of Anesthesiology and Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA. anna.varughese@cchmc.org
authors.forename: Anna M
authors.initials: AM
authors.lastname: Varughese
authors.forename: Elena
authors.initials: E
authors.lastname: Adler
authors.forename: Amy
authors.initials: A
authors.lastname: Anneken
authors.forename: C Dean
authors.initials: CD
authors.lastname: Kurth
mesh_terms: D000046:Academic Medical Centers / Q000592:standards; D001071:Appointments and Schedules; D002648:Child; D003299:Cooperative Behavior; D017598:Efficiency, Organizational / Q000592:standards*; D006284:Health Plan Implementation / Q000592:standards; D006801:Humans; D033183:Interdisciplinary Communication; D009820:Ohio; D013517:Otorhinolaryngologic Surgical Procedures / Q000592:standards*; D058996:Quality Improvement / Q000458:organization & administration*; D013996:Time and Motion Studies; D057188:Workflow